Ruth Taylor, left, and Benjamin Knoll are among the many Kentuckians who have tried prescription weight loss drugs. (Photos submitted)
This story discusses weight and eating disorders. If you or someone you know has an eating disorder, you can get help through the National Eating Disorder Association by calling 800-931-2237 or chatting online at nationaleatingdisorder.org.
When Ruth Taylor got accepted into a trial to study semaglutide — which most people know as the brand name Ozempic — as a weight loss medication, she thought it would be “a dream.”
The Oldham County woman, 70, experienced “significant” weight loss quickly while injecting herself once a week with the drug for about six months in 2018.
But when the trial ended with no time to wean herself off the drug, she stopped the shots abruptly. Then, “almost immediate,” she said, all the lost weight returned — and then some. This happened despite very little change in her eating habits, she said.
“Nothing I did would slow it down or stop the rapid weight gain,” Taylor said, describing the ordeal as a “rollercoaster” she wouldn’t want to endure again.
She thinks it would have helped her if she could have weaned her body off the drug rather than quit it quickly.
There were positives to taking it, though, she said. The food diary she kept during the trial helped her understand her own daily habits better. But she found the treatment itself too drastic and unsustainable. She doesn’t know the outcome of the trial she was in.
Use of Ozempic is highly prevalent in Kentucky thanks to the state’s high rate of diabetes diagnoses.
Some researchers worry about misuse among people with — or genetically disposed to having — eating disorders, as preliminary data suggests more than 1 in 10 eating disorder patients also used Ozempic, an injection intended to treat diabetes.
But the the drug is helpful if obtained and used legally and in line with proper medical guidance, experts say.
The latter was Benjamin Knoll’s experience. The Danville man was pre-diabetic and had high blood pressure and cholesterol when he and his doctor decided to try Zepbound, which is similar to ozempic and is approved for weight loss.
He initially resisted the idea of the medication, citing internal “stigma.” He wanted to lose weight, but “I wanted to do it … the old fashioned way.”
Knoll got on the shot in December and experienced regular nausea for about a week before that decreased.
He doesn’t yet know how long he’ll take Zepbound, but doesn’t intend to do so forever. His private insurance pays only part of the cost — he’s out of pocket $200 a month, or $50 per shot — and he doesn’t want to be reliant on it, either.
“I’m already thinking of, proactively, … what will I need to do in terms of my own personal habits to maintain the goal that I get to and not have to go back and do this again in five years,” he said.
During the 2023-2024 fiscal year, Kentucky Medicaid paid out $251 million for GLP-1 medication to treat 76,195 people, according to Cabinet for Health and Family Services spokeswoman Kendra Steele. GLP-1 refers to a class of medications that treat blood sugar, under which Ozempic falls.
Kentucky Medicaid “only covers GLP-1 medications that have been prescribed for the treatment of diabetes,” Steele said. “Team Kentucky is dedicated to supporting the health and well-being of Medicaid recipients who are disproportionately affected by diabetes.”
Kentucky has the nation’s sixth highest rate of diabetes, which costs the state about $5 billion annually as of 2022, according to the American Diabetes Association.
How does Ozempic work?
There’s no cure for diabetes, but ozempic mimics a normal hormone release that people with Type 2 diabetes don’t have, explained Brooke Hudspeth, the chief practice officer (CPO) for the UK College of Pharmacy and an associate professor of pharmacy.
Ozempic was “initially approved for treatment of Type 2 diabetes, so it was originally approved to help lower blood glucose in patients that have Type 2 diabetes,” said Hudspeth.
A weekly shot — which patients can inject into the stomach or thigh — slows gut motility and makes a person feel full, Hudspeth explained.
“Foods kind of sit in your gut a little bit longer, so it doesn’t pass through as quickly, and so you don’t have quick absorption of … those sugars, or that blood glucose,” she said.
But such medications shouldn’t be taken without also making lifestyle modifications, she said.
“We really want to emphasize a treatment plan (in which) the foundation is lifestyle modification,” she said. “So these medications are important, they’ve had great outcomes, they show success, patients tolerate them well. But we also want to ensure that we’re doing that in collaboration with lifestyle management strategies.”
Usually those lifestyle adjustments are eating more nutritious food and increasing physical activity, she said. Such adjustments were key for Knoll.
While taking Zepbound, Knoll’s insurance requires him to see a health coach, who’s made a big difference in his life, he said.
When he first started the injection treatment in December 2024, Knoll thought he might eat one meal a day on the drug. His health coach rejected that, stressing the importance of eating regular meals and focusing on consuming nutritious foods and prioritizing protein.
His migration toward eating more protein — mainly fish — has also helped his cholesterol and blood pressure, he said. He is also taking medicine for those issues. He is no longer pre-diabetic.
The approval of GLP-1s marked a “shift in the way that we manage patients,” Hudspeth said. “We’re seeing so many of these other benefits that they are having, aside from just lowering blood glucose, or even aside from just the weight loss piece that we’re seeing those prescribed.”
That includes, she said, “decreasing cardiovascular risk…which is a major concern in patients with diabetes.”
Could this ‘magic drug’ cause or worsen eating disorders?
University of Louisville researchers who study eating disorders are worried about Ozempic’s impact on eating disorders, which will affect 9% of Americans in their lifetimes and are one of the deadliest mental illnesses.
MD-Update, a Kentucky and Southern Indiana medical publication, estimated in 2024 that there were about 900,000 Kentuckians, including 29,000 children, with eating disorders.
Cheri Levinson, an associate professor with the university and the director of Louisville’s Eating Anxiety Treatment Laboratory (EAT Lab), surveyed about 120 people in 2024 who were seeking care for eating disorders. Of those, about 11% said they had used or were using Ozempic.
“Eleven percent … is pretty high for people who are specifically coming in for eating disorder treatment,” Levinson said. “I can guarantee that every single one of those people is already struggling with (food) restriction. And then you add … use of Ozempic on top of it. Very problematic.”
Now, she wants to learn more about the relationship between eating disorders and Ozempic use. She and Nicholas Peiper, an associate professor of Epidemiology & Population Health and a scientist at the University of Louisville’s EAT Lab are launching a pilot study this year to do just that.
For about a year, the two will try to survey about 1,000 people with eating disorders to learn how prevalent Ozempic use is among that population, as well as how they obtained the drug.
They also want to learn “if they really are harmful, or are they helpful, for eating disorders,” Levinson said. “If they are harmful, then the (Food and Drug Administration), or whoever it is, needs to think about being explicit that this could be harmful for certain populations, because right now, it’s just being marketed as this great thing for everything, instead of thinking about the possible harms that it could cause.”
Both Taylor and Knoll said they have no personal history of eating disorders. But researchers worry for those who are genetically predisposed to developing them.
“We know that restriction is the primary component of all eating disorders,” Levinson said. “Eating disorders have a long history of misusing diet pills and supplements and using any means possible to restrict food intake to lose weight. Now we have a ‘magic’ drug that basically causes people to lose their appetite and restrict. And that’s the worry — that these are going to be used as a way to help the eating disorder, essentially … to help restrict, to help maintain the eating disorder.”
‘A reality where everybody can win’
Nearly 30 million Americans will have an eating disorder at some point in their life, according to the National Eating Disorders Association. Yet misconceptions about them are still deeply rooted in society.
“People make this assumption that unless you’re very, very thin, you don’t have an eating disorder, and that is just not accurate at all,” Levinson said. “Most people with eating disorders — 80% — are in medium or large bodies.”
There may also be an addictive component to eating disorders, Peiper said.
“People with eating disorders also are at vastly increased risk of having a substance use disorder compared to the general population,” he said. “There are interesting relationships that people with eating disorders have with various drugs and using them for particular reasons to drive their eating disorder behaviors and symptoms and in ways that are … slightly different than the traditional addictive processes of using substances to achieve euphoria and becoming addicted and entering that sort of cycle.”
Peiper and Levinson also want to investigate if there are addictive components to taking something to alter weight.
Though dieting medications “are not psychoactive drugs,” there’s concern about the behavior they reinforce, Peiper said.
“I would say that restriction in particular is a compulsive behavior,” he said. “It’s very cyclical in nature. So, it’s effectively priming restriction and priming a compulsive behavior.”
Both Levinson and Peiper said their concern is not for people who medically need Ozempic and related medications.
“These drugs can be extremely beneficial, and I’ve heard lots of stories about that. There are particular patient populations that could greatly benefit from these drugs,” Peiper said. “If we can find that balance between what potential contraindications might be, what comprehensive (eating disorder) screening might be, I think that there’s a reality where everybody can win.”
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